The Insurance Regulatory and Development Authority (IRDA) on Wednesday issued a master circular on health insurance, making it clear that the insurance company will have to take a decision on allowing cashless treatment within one hour of the request.
Cashless Treatment: The Insurance Regulatory and Development Authority (IRDAI) on Wednesday issued a master circular on health insurance and made it clear that the insurance company will have to decide on allowing cashless treatment within one hour of the request. IRDAI said in a statement that the master circular on health insurance products has repealed 55 circulars issued earlier and is an important step towards empowering policyholders and strengthening inclusive health insurance.
Big decision in the interest of the policyholder
The insurance regulator said, “The circular brings together the entitlements in the health insurance policy available to the policyholder/potential at one place for their easy reference and also emphasizes on measures to provide seamless, faster claim experience to the policyholder purchasing health insurance and to ensure advanced service standards in the health insurance sector.”
It states that decisions on cashless authorization requests must be taken immediately and within one hour and final settlement must be given on discharge from the hospital within three hours of the request from the hospital.
Cashless payment within three hours
Earlier, a lot of efforts had to be faced for cashless payment in health insurance, but now it will be done within three hours of receiving the discharge request from the hospital. In a circular issued by insurance regulator IRDAI on 29 May 2024, it has been said that in any case, the health insurance company will have to make cashless payment of the claim made by the policyholder within three hours of receiving the discharge request from the hospital.
Along with this, in any case, the insured will not have to wait till the patient is discharged from the hospital. If there is a delay of more than three hours, then in such a situation any additional charge taken by the hospital will be funded by the insurance company to the shareholder.
If the insured dies during treatment…
IRDAI has clearly stated in its Master Circular that under the new guidelines, if a health insurance holder dies during treatment in the hospital, then in this situation the insurance company will have to immediately start the process of payment of the claim. Not only this, along with this, the body of the deceased will also have to be removed from the hospital as soon as possible.
The insurance regulator has also changed the rules for emergency cases. The insurance company will have to take an immediate decision on cashless payment within one hour of receiving the request. Along with this, IRDAI has directed the insurance companies to complete this work by 31 July 2024, and for the convenience of the people, insurance companies should also create a help desk in the hospital if possible so that the process of cashless payment can be made easier.
